Abstract：
OBJECTIVE: Recommendations on cardiac resynchronization therapy (CRT) in patients with atrial fibrillation or flutter (AF) are based on less robust evidence than those in sinus rhythm (SR). We aimed to assess the efficacy of CRT upgrade in the BUDAPEST-CRT Upgrade trial population by their baseline rhythm.
RESULTS: Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).
CONCLUSIONS: In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.
RESULTS: Heart failure patients with reduced ejection fraction (HFrEF) and previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and ≥20% right ventricular (RV) pacing burden were randomized to CRT with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). Primary [HF hospitalization (HFH), all-cause mortality, or <15% reduction of left ventricular end-systolic volume] and secondary outcomes were investigated. At enrolment, 131 (36%) patients had AF, who had an increased risk for HFH as compared with those with SR [adjusted hazard ratio (aHR) 2.99; 95% confidence interval (CI) 1.26-7.13; P = 0.013]. The effect of CRT-D upgrade was similar in patients with AF as in those with SR [AF adjusted odds ratio (aOR) 0.06; 95% CI 0.02-0.17; P < 0.001; SR aOR 0.13; 95% CI 0.07-0.27; P < 0.001; interaction P = 0.29] during the mean follow-up time of 12.4 months. Also, it decreased the risk of HFH or all-cause mortality (aHR 0.33; 95% CI 0.16-0.70; P = 0.003; interaction P = 0.17) and improved the echocardiographic response (left ventricular end-diastolic volume difference -49.21 mL; 95% CI -69.10 to -29.32; P < 0.001; interaction P = 0.21).
CONCLUSIONS: In HFrEF patients with AF and PM/ICD with high RV pacing burden, CRT-D upgrade decreased the risk of HFH and improved reverse remodelling when compared with ICD, similar to that seen in patients in SR.
摘要：
目的：关于房颤或扑动（AF）患者心脏再同步化治疗（CRT）的建议依据的证据不如窦性心律（SR）患者。我们旨在通过基线节律评估BUDAPEST-CRT升级试验人群中CRT升级的疗效。
结果：射血分数（HFrEF）降低且先前植入起搏器（PM）或植入式心脏复律除颤器（ICD）且右心室（RV）起搏负荷≥20％的心力衰竭患者被随机分配接受CRT和除颤器（CRT-D）升级（n=215）或ICD（n=145）。原发性[HF住院（HFH），全因死亡率,或左心室收缩末期容积减少<15%]和次要结局进行调查.在入学时，131例（36%）患者有房颤，与SR患者相比,HFH风险增加[校正风险比(aHR)2.99;95%置信区间(CI)1.26-7.13;P=0.013].在平均随访时间12.4个月期间，房颤患者的CRT-D升级效果与SR患者相似[房颤调整比值比(aOR)0.06;95%CI0.02-0.17;P<0.001;SRaOR0.13;95%CI0.07-0.27;P<0.001;交互作用P=0.29]。此外，它降低了HFH或全因死亡率的风险(aHR0.33;95%CI0.16-0.70;P=0.003;交互作用P=0.17),并改善了超声心动图反应(左心室舒张末期容积差-49.21mL;95%CI-69.10~-29.32;P<0.001;交互作用P=0.21).
结论：在具有高RV起搏负荷的房颤和PM/ICD的HFrEF患者中，与ICD相比，CRT-D升级降低了HFH的风险并改善了反向重塑，与SR患者相似。
结果：射血分数（HFrEF）降低且先前植入起搏器（PM）或植入式心脏复律除颤器（ICD）且右心室（RV）起搏负荷≥20％的心力衰竭患者被随机分配接受CRT和除颤器（CRT-D）升级（n=215）或ICD（n=145）。原发性[HF住院（HFH），全因死亡率,或左心室收缩末期容积减少<15%]和次要结局进行调查.在入学时，131例（36%）患者有房颤，与SR患者相比,HFH风险增加[校正风险比(aHR)2.99;95%置信区间(CI)1.26-7.13;P=0.013].在平均随访时间12.4个月期间，房颤患者的CRT-D升级效果与SR患者相似[房颤调整比值比(aOR)0.06;95%CI0.02-0.17;P<0.001;SRaOR0.13;95%CI0.07-0.27;P<0.001;交互作用P=0.29]。此外，它降低了HFH或全因死亡率的风险(aHR0.33;95%CI0.16-0.70;P=0.003;交互作用P=0.17),并改善了超声心动图反应(左心室舒张末期容积差-49.21mL;95%CI-69.10~-29.32;P<0.001;交互作用P=0.21).
结论：在具有高RV起搏负荷的房颤和PM/ICD的HFrEF患者中，与ICD相比，CRT-D升级降低了HFH的风险并改善了反向重塑，与SR患者相似。
